HSE fails to collect up to €74m from private health insurers – report

Committee highlights ‘unacceptable’ litany of failings

John McGuinness TD, chairman of the Public Accounts Committee. “Consultants were not signing off on claims and ¤74 million worth of claims had not been submitted for collection from the private health insurers . . . that is no way to run a health service,” he said yesterday. Photograph: Brenda Fitzsimons

The Dáil Committee of Public Accounts has strongly criticised the Health Service Executive for not collecting up to €74 million in claims from private insurers and for its failure to realise anticipated cost savings.

In a new report the committee, chaired by Fianna Fáil TD John McGuinness, also criticised the fact the State is still paying more for drugs than the authorities in other comparable countries.

Although committee members from Fine Gael said the litany of failings highlighted in the report were unacceptable, none said Minister for Health James Reilly was at fault in any way.

The report, based on the committee’s examination of work carried out by the Comptroller & Auditor General, made 16 recommendations.

These included a call on the Department of Public Expenditure to conduct a benchmarking exercise to compare hospital consultants’ pay in Ireland with their pay in other countries.

The committee also said the department should review the HSE’s budgeting model and issued a demand for the HSE to examine whether there is scope to publish the names of hospital consultants who are holding up the collection of income from insurers.

“What we found most disturbing is that at a time when it was under financial pressure, the HSE had failed to put procedures in place so as to collect the income it was due,” Mr McGuinness said.

“Consultants were not signing off on claims and €74 million worth of claims had not been submitted for collection from the private health insurers.

“Between €5 million and €8 million was outstanding for over 12 months: that is no way to run a health service and while steps were taken throught the LRC to ensure that consultants signed off on claims within 14 days, we will follow up with the HSE to ensure that it collects the money it is owed promptly.”

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The HSE’s spokeswoman said in response that health insurers made advance payments of €104 million last year, leading to a “significant improvement” in its financial position at year-end. “Systems have been put in place to improve income collection, including electronic claims to replace what was a manual system.”

The report highlighted how more than €2.6 million in allowances was paid to 31 hospital consultants who retired in 2011 in lieu of accumulated rest days, and said payments of more than €175,000 were made to eight of the consultants.

The report said the HSE was not in a position to quantify the number of former staff who were employed as agency staff in the public health system and noted that the cost of employing an agency worker was similar to the cost of directly employing that worker.

Present with Mr McGuinness at the publication of the report were Fine Gael TDs Kieran O’Donnell, Paschal Donohoe, Eoghan Murphy and Simon Harris. There was no criticism of Dr Reilly from these TDs. “This for me confirms the need to put in place the kind of governance arrangements that Minister Reilly is talking about,” said Mr Donohoe.